Provider Demographics
NPI:1982885133
Name:MIRANDA DE ANYANWU, ENEDELIA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ENEDELIA
Middle Name:
Last Name:MIRANDA DE ANYANWU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 LIVE OAK CIR APT B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9283
Mailing Address - Country:US
Mailing Address - Phone:956-208-9307
Mailing Address - Fax:
Practice Address - Street 1:1327 E WASHINGTON AVE # 282
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5684
Practice Address - Country:US
Practice Address - Phone:956-208-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28751171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151175003Medicaid